Guam Adolescents' Use of Strategies to Resist Cigarette, e-Cigarette, and Betel Nut Offers: Findings from a Focus Group Study.

: This study examined resistance strategies used by predominantly Pacific Islander young adolescents in response to offers of tobacco, e-cigarettes, and betel [areca] nuts. This study was intended to inform the development of a prevention curriculum focused on training young adolescents from the U.S.-Affiliated Pacific Islands (USAPI) on culturally appropriate strategies to resist substance use offers. Currently, very little is understood in terms of how Pacific Islander youths deal with tobacco and other substance use offers, although the use of tobacco products among Pacific Islander youths is high. Specifically, given the collectivist sociocultural orientation of the Pacific Islander communities, it is unclear whether the direct (overt) confrontational style of resistance is a viable mode of resistance for youths to practice when faced with a substance use offer. : We conducted 10 focus groups with public middle school students ( = 34) from Guam, which is part of the USAPI. : Results suggested that, as with other communities in the U.S., the resistance strategies fall into two categories-overt/confrontational and non-confrontational resistance strategies. Overt/confrontational strategies included (a) saying "no" and (b) verbally confronting the offeror. Non-confrontational strategies included (a) avoiding or leaving the situation and (b) telling an adult. : Our findings have implications for the development of culturally grounded interventions aimed at preventing youth tobacco and other substance use in Guam, the USAPI, and the Pacific region.